Thoracic Mechanics: Ditching the Quasimodo

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Article written by Seth Larsen

Let’s imagine everyone reading this article is in a large seminar room.  You are surrounded by Strong(wo)men, Powerlifters, CrossFitters, Olympic lifters, and every other manner of strength athlete.  Got it? Good.  Ok, everybody close their eyes.  Now raise your hand if you’ve ever had shoulder pain.  Upper back pain? Neck pain?  Now look around.  By this point, I’d venture a guess to say each one of you has a hand in the air.  I’m equally as confident in saying that before you started on this crazy journey of strength athletics, you could raise that hand at least somewhat, if not significantly, higher.  It’s no secret that our chosen past time wreaks absolute havoc on the shoulder girdle and thoracic spine.  This is likely not news to any of us.  Now what if I told you that many of these problems we have developed can be mitigated, if not prevented, by increasing the mobility and stability of your shoulders and thoracic spine?  I bet you’re a little more interested now.


We all know that having a strongupper back is crucial to performing well in our strength sport of choice  However, as many of us injury prone idiots have discovered (myself included), strength is not enough.  Strong, powerful shoulders and upper backs are pretty useless if they cannot move in an efficient fashion to perform the lifts we train and compete in.  Whether it is in the bench press, overhead press, snatch, clean, or even squatting and deadlifting, poor posture and bad mechanics are a recipe for disaster.   It’s no wonder that shoulder and back injuries account for nearly 50% of the injuries in strongman (I would argue it’s likely higher than this, but that is for another time).


This all seems pretty obvious, right?  You would think so.  Unfortunately, as we get bigger, stronger, and busier, mobility tends to be the first thing that suffers.  I can say firsthand that I’d much rather be moving some heavy iron around than doing what looks like weird yoga movements next to the squat rack.  It’s pretty difficult to get bigger and stronger if you’re beat up all the time, however.  Some basic understanding of upper extremity anatomy and dedication to some easy prehab exercises can nip many of these injuries in the bud.


Let’s start with the anatomy of the shoulders and upper back.  First the big guns; our prime movers here are the deltoid, trapezius, and latissimus dorsi.  These are the muscles that we tend to think of when we train our shoulders and upper back, but they are only a piece of the puzzle.  We also have our postural muscles: the rhomboid major, rhomboid minor, teres major, and levator scapulae. Lastly, we come to the stabilization complex of the shoulder joint, the rotator cuff.  This is composed of the supraspinatus, infraspinatus, teres minor, and subscapularis.  While each muscle has a specific action, their overall functions fall into these groups; any imbalance between them can lead to a mobility and/or stability dysfunction, which can ultimately result in reduced performance and increased likelihood of serious injury.  If the big guns are strong, but have no support from the postural muscles, you’ll cave when trying to move heavy loads with them.  If you’ve managed to strengthen both of these groups and try to throw a big weight overhead without properly taking care of your rotator cuffs, you can literally blow your arm out of the socket.  If everything is strong but tight and immobile, you run into a different set of problems which can lead to injuries that are equally as scary.






There’s no reason for me to write about how to get your delts, traps, and lats stronger.  You guys already know how to do this.  However, has this really helped your posture? Your shoulder pain? I’m betting it probably didn’t fix your neck issues either and that you’re still walking around with your head pushed forward, shoulders internally rotated, and a hyperflexed thoracic curve that makes you look like Quasimodo.  Sitting at a desk in front of a computer all day and tightening up your anterior musculature is only making this worse.  WAY worse. Not only is it keeping potential mates away, but this posture is very problematic from a biomechanical standpoint.



                               Bad thoracic mechanics mean you have to date gargoyles. Science.
 An easy way to make sense of why this is such an issue is in the back squat, when a large external load is being placed directly onto the thoracic spine.  When the spine is in flexion, the posterior disc space widens.  Therefore, hyperflexion due to poor posture creates an even greater posterior disc space.  Due to spinal ligamentous anatomy, the vast majority of disc herniations occur in the posterior direction.  So lets put two and two together: increased spinal flexion with a compressive load puts us at an increased risk for vertebral disc injury.  Increased thoracic flexion also puts you in a compromised position in pressing movements.


 In the overhead press, these poor mechanics, coupled with the lack of shoulder mobility that often accompanies them (increased flexion of the thoracic spine automatically throws the shoulders forward), create difficulty in getting the head through and shoulders back without hyperextending the lumbar spine.  It doesn’t take an orthopedic surgeon to tell you why hyperextension of the spine is a poor choice for athletic longevity.  Ever see the big, fat guys walking around with their butts sticking out?  They are in constant hyperextension of the lumbar spine.  I can tell you from clinical experience that this is an extremely common cause of low back pain. Poor thoracic mechanics and shoulder mobility also creates problems in the bench press; when the thoracic spine is locked in flexion, the lifter loses his or her arch, lengthening the path the bar must travel.  Not only will this reduce the amount of weight you are able to lift (both via the change in distance and the way it impinges your leg drive), but it also makes it more difficult to keep the glutes on the bench, ultimately resulting in those horrible red lights no powerlifter ever wants to see.


I could sit here and list a bunch of studies I read to get ready for this article about injuries related to forward head posture and poor thoracic mechanics, such as brachial plexus syndrome and thoracic outlet syndrome (which can lead to paralysis of the upper extremity, among other nasty things), shoulder impingements, frozen shoulder, scapular dyskinesia, rotator cuff tears, and spinal osteoarthritis, but enough with the postural boogeyman stories.  Let’s start fixing this mobility issue so we can get back to smashing PR’s, right? Now that we have a good grasp on the anatomy and its importance, we can break down the aforementioned functional groups and fix their problems.  I’ll go through some basic warmup/prehab movements first to improve mobility and activate the muscles we all need to get better at firing, some specific strengthening exercises to create a more stable upper back and shoulder girdle overall.  Here’s a list of what I do every training session (well, almost; I’m human too) to maintain and improve in these areas, followed by a video of what they should look like.


Thoracic/Shoulder Mobilization Prehab Complex (before training)

–Arm circles (small) x10 each direction

-Arm circles (big) x10 each direction
-Alternating internal/external rotations in abduction x10 each arm

-Thoracic spine SMR rollout (slow and controlled, let all the vertebrae open up)

-Roller shoulder external rotations x10

-Wall press 2×10

-Pullup bar dead hang 2×10-15sec (not in video. Just hang from a pullup bar at full extension)

-SB pec minor stretch 3×3-5sec each side (contract and push for 3-5sec, then relax and sink deeper into ball.)

-Shoulder dislocations with stick/PVC pipe x10

-Band external rotations x10 each arm

-Band pull-aparts x50

 -Thoracic bridges (This is a more advanced movement, and I am still learning them myself.  They are very difficult if you have poor mobility, so do all the other stuff for at least a month before you try them.  My form needs serious improvement, so here is a much better video explaining them from my good buddy and ridiculous athlete Max Shank:http://www.youtube.com/watch?v=rm9L0RIhR3s)


Thoracic/Shoulder Stability and Strength Complex (to finish training)

-Prone cobras 3x30sec (progress up to 60sec each, relax glutes completely during exercise)

-Band face pulls 3×15

-Band pull-aparts x50

-More thoracic bridges (see above)



One thing to focus on through all of these is to make sure you keep your head neutral.  This will further aid you in prevention and correction of thoracic hyperkyphosis and forward head posture.  I can’t promise you this is going to fix all your shoulder issues, but it should give you a fighting chance.  Disclaimer: if any of these movements cause you significant pain, DON’T DO THEM!  A little mobility work, some SMR, and playing around with bands is no substitute for a medical professional.  With any luck, though, this will help you stay out of the doctor’s office and on the platform.  It will even assist in prevention of (or at least delay) the development of chronic neck and shoulder pain as you age, in turn keeping you stronger, longer. Improving your thoracic mechanics should also make you look a little more like the guy on the left in the picture below than the guy on the right.  And let’s be real, who do you think came out on top in that battle?



P.S. Now that you’ve just spent a few minutes hunched over a computer with what is probably awful posture, get up and move that thoracic spine around.  Do this consistently and often.  You’ll thank me in the gym. 


Seth Larsen has a Bachelor’s of Science in Biology and Neuroscience and is a Doctor of Osteopathic Medicine candidate for 2015 at Midwestern University.  He is a former NASM-CPT and student athletic trainer.  He currently serves as a reserve officer in the US Navy Medical Corps while he finishes medical school with a specialization in primary care sports medicine.  Seth is a former NCAA football player who now competes as a LW (105kg) strongman, Highland Games athlete, and Powerlifter.


References:

1.      Simons, S.M., Dixon, J.B. “Physical examination of the shoulder.” Uptodate.com, Nov 2013.

2.      Quek, J., Pua, Y-H, Clark, R.A., Bryant, A.L. “Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults.” Manual Therapy, Feb 2013; 18(1):65-71

3.      Nairn, B.C., Azar, N.R., Drake, J. “Transient pain developers show increased abdominal muscle activity during prolonged sitting.” Journal of Electromyography and Kinesiology, Dec 2013; 23(6):1421-1427

4.      Anderson, B.C. Office Orthopedics for Primary Care: Diagnosis, 3rd edition. WB Saunders, Philadelphia 2005.

5.      Reinold, M.M., Escamilla, R.F., Wilk, K.E. “Current concepts in the scientific and clinical rationale behind exercises for glenohumeral and scapulothoracic musculature.” Journal of Orthopedic Sports Physical Therapy, 2009; 39:105.

6.      Tsang, S., Szeto, G., Lee, R. “Altered spinal kinematics and muscle recruitment pattern of the cervical and thoracic spine in people with chronic neck pain during functional task.” Journal of Electromyography and Kinesiology, Feb 2014; 24(1):104-113.

7.      Winwood, P.W., Hume, P.A., Cronin, J.B., Keogh, J.W. “Retrospective injury epidemiology of strongman athletes.” Journal of Strength and Conditioning Research, Jan 2014; 28(1):28-42

  • If only this article could have come a few months ago….

    I am a collegiate rower and amateur (18 months) weightlifter. I never had a skilled lifter observe my form or teach me technique, and have recently been diagnosed with severe brachial plexus syndrome. Underdeveloped rotator cuff? Check. Previous history of low back pain? Check. Chronic loss of feeling in the hand? Check. Constant Neck & Shoulder pain? Check.

    From my research and what has been explained to me by my PT, Ortho, and Primary Care, EVERYTHING Seth has to say in this article is completely accurate. Trust the man, and do the mobility work so you don’t end up like me.

  • Farlet,
    I am sorry to hear you had to go through that, but thank you for the kind words about the article. I hope it helps your recovery. What treatment options have you worked through at this point? I might have some ideas for how to move forward. Let me know.

  • Seth,
    Check my profile for my email so we can discuss off the thread.
    -Tyler

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